An update on chemical pharmacotherapy options for the prevention of kidney transplant rejection with a focus on costimulation blockade

• Verfasst von: Kälble, Florian [VerfasserIn]
• Verfasst von: Schaier, Matthias [VerfasserIn]
• Verfasst von: Schäfer, Sebastian Markus [VerfasserIn]
• Verfasst von: Süsal, Caner [VerfasserIn]
• Verfasst von: Zeier, Martin [VerfasserIn]
• Verfasst von: Sommerer, Claudia [VerfasserIn]
• Verfasst von: Morath, Christian [VerfasserIn]
• Titel: An update on chemical pharmacotherapy options for the prevention of kidney transplant rejection with a focus on costimulation blockade
• Verf.angabe: Florian Kälble, Matthias Schaier, Sebastian Schäfer, Caner Süsal, Martin Zeier, Claudia Sommerer, Christian Morath
• E-Jahr: 2017
• Jahr: 09 May 2017
• Umfang: 9 S.
• Fussnoten: Published online: 09 May 2017 ; Gesehen am 07.08.2018
• Titel Quelle: Enthalten in: Expert opinion on pharmacotherapy
• Ort Quelle: Abingdon, Oxon : Routledge, Taylor & Francis, 1999
• Jahr Quelle: 2017
• Band/Heft Quelle: 18(2017), 8, Seite 799-807
• ISSN Quelle: 1744-7666
• DOI: doi:10.1080/14656566.2017.1323876
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: belatacept
• Sach-SW: calcineurin inhibitors
• Sach-SW: chronic antibody-mediated rejection
• Sach-SW: immunosuppressive regimens
• Sach-SW: Kidney transplantation
• Sach-SW: mammalian target of rapamycin inhibitors
• K10plus-PPN: 1578347823

Abstract

Introduction: The introduction of calcineurin inhibitors (CNI) has greatly improved graft survival in the past three decades. However, long-term graft survival is still limited due to chronic allograft injury and side-effects of immunosuppressive medication. Areas covered: The present overview gives an update on pharmacotherapeutic strategies after kidney transplantation. The main focus is on CNI-sparing regimens using co-stimulatory blockade and on new substances on the horizone. Expert opinion: CNI sparing regimens are well-established. Complete CNI avoidance after kidney transplantation was often associated with impaired graft survival until the approval of the co-stimulation blocker belatacept for de novo immunosuppression after kidney transplantation. Concerns still exist with respect to severe T-cell-mediated rejection episodes in the early phase after transplantation. Thus, a triple drug regimen with CNI, mycophenolic acid and steroids still represents the gold-standard of immunosuppressive therapy. Alternative substances expand the possibilities of tailoring individual immunosuppression for different indications such as biopsy-proven CNI toxicity, polyoma virus BK nephropathy or CNI-triggered thrombotic microangiopathy. However, a change of the immunosuppressive therapy must always be balanced against each patient´s individual immunological risk in order to address the importance of chronic antibody-mediated rejection driven by donor specific antibodies (DSA).